Caring for the Mentally Ill

As the 19th Century came to a close, city institutions for the mentally ill were overflowing. The hospitals were little more than warehouses, and treatment and therapy were negligible. Progressive doctors argued that the solution lay to the east -- to Long Island where patients could breathe fresh air and be productive in fields or workshops.

Their recommendations resulted in a system of three major state hospitals on Long Island that would serve hundreds of thousands of patients and create new communities for tens of thousands of workers.

The philosophy that these hospitals represented was best described in 1895 by Dr. George Smith, the first director of a new facility in Central Islip. He summed up his treatment regimen as ``O&O and R&R.''

The initials stood for ``occupation and oxygen'' and ``rest and recreation.''

The first hospital was built in a quiet farming community that would become Kings Park. In 1885, officials of what was then the City of Brooklyn established the Kings County Farm on more than 800 acres to care for the poor and the mentally ill.

``At the time, 32 male and 23 female patients were moved to three hastily constructed wooden houses ... where the stresses and unhealthy conditions of city life would be alleviated, thereby assisting in their cure,'' Kings Park Psychiatric Center historian Leo Polaski wrote in a recent history.

While Brooklyn patients were going to Kings Park, mental hospitals in Manhattan also were overflowing. In 1887, the city purchased 1,000 acres of pine barrens in Central Islip. The first 49 male patients arrived at the New York City Farm Colony in 1889 and were put to work building the hospital. They were joined the following year by 40 female patients who handled household tasks.

As new buildings went up at Kings Park, so did the patient population. Soon, overcrowding eroded patient care and there were complaints about patronage, waste and graft. Protests by the medical staff and the public spurred the state to take over both the Kings Park and Central Islip facilities in 1895.

At the turn of the century, Kings Park in just 15 years had grown to 2,697 patients and a staff of 454 -- giving the hospital a larger population than the rest of the Town of Smithtown.

By 1928, overcrowding both in the city and on Long Island brought state approval of a third institution in Suffolk that would become the largest psychiatric hospital in the world. Pilgrim State -- named after mental health pioneer Dr. Charles Pilgrim -- was built on more than 1,057 acres in Brentwood. It opened on Oct. 1, 1931. Eight years later, the state bought 875 acres to the west and built Edgewood State Hospital. It was operated as a federal military hospital during the war and returned to the management of Pilgrim in 1946. It was closed in 1971.

In the early years of Kings Park and Central Islip, about half the employees were Irish immigrants. ``We had a bus that used to go from the hospital to the docks in Manhattan and pick them up,'' said Central Islip's historian, Muriel Remsen. During World War II, when many employees joined the armed forces, Central Islip recruited black workers from the Carolinas, which led to cultural changes in mix of the community.

All the hospitals prided themselves on being self-sufficient farm communities. At Kings Park, the three wooden houses grew into more than 150 permanent buildings, including a bakery, laundry, amusement hall, bandstand, library, furniture repair shops and nursing school.

At Central Islip, where doctors early in this century helped isolate the bacteria that caused syphilis, patients held a variety of jobs. ``They made their own shoes, they made their own bricks, they made their own park benches, their own water fountains, birdbaths, their own clothing, mattresses and brooms,'' said Remsen. A fire department was organized in 1907 with 10 volunteer employees.

Pilgrim even had its own courts. Central Islip, Pilgrim and Kings Park built their own railroad spurs. Central Islip had five miles of track on the grounds and its own locomotive and special hospital car to carry patients from Long Island City to the hospital and back.

Life for patients and staff was highly regimented. Central Islip employees lived on the grounds and were not allowed off the property, even during their off hours. They had to wear ties or buttoned-up blouses on duty -- even when they were bathing patients -- and were forbidden to bicycle around the grounds. Staff and patients did get eggs, oysters or clams once a week and poultry twice a month. Because there was a farm, there were plenty of vegetables.

For therapy and to raise money for hospital activities, the patients were encouraged to engage in crafts. The birdhouses and toys they made at Central Islip were sold to the public once a year, and the variety shows produced by the patients until the 1960s always drew sellout crowds from the community. Central Islip patients were given their own garden plots and competed for produce prizes at county fairs.

Over time, the philosophy of ``O&O and R&R'' gave way to new techniques. Insulin shock therapy was used at Pilgrim in 1936 and electric shock therapy was introduced in 1940. Prefrontal lobotomies were performed there beginning in 1946. Drug-based treatment arrived in the 1950s, starting with Thorazine, and patient populations began to decline. Kings Park's peak came in 1954 with 9,300 patients. Central Islip had its maximum patient population -- 10,000 -- in 1955. And Pilgrim topped out at 15,000 in the late 1950s.

Drug therapy combined with a push to ``decentralize'' psychiatric patients into community facilities or outpatient treatment lessened the need for the mammoth complexes. Kings Park and Central Islip closed in 1996, with most of their remaining patients transferred to Pilgrim Psychiatric Center, which now serves 1,200 inpatients.

In Central Islip, most of the hospital grounds have been taken over by New York Institute of Technology, court buildings, senior housing, a business park, a public elementary school and other facilities. The Kings Park facility is up for sale by the state.

The empty brick hospital buildings left behind seem stark and Dickensian now, relics of a less enlightened age. But former employees say the institutions were pleasant places. King Pedlar, who worked at Kings Park and lived on the grounds for 31 years, recalled that ``the biggest thing that struck me was that the outside of the buildings had a scary, dismal look, but when you went inside, there was such a cheerfulness. When you're inside, you really don't notice the bars. It wasn't a snake pit kind of a place. The whole place was like an oasis.''